Lesson Plan #4 Title: The Hippocratic Oath
Performance Objective: Given 3 problem solving strategies/approaches and a case
study, students will use problem solving sub-skills to create a presentation and
accompanying justification of the group selection of the best strategy to apply to
the patient in the case study, scoring a minimum of 3 on each evaluated area of the
given rubric.
Resources or Materials Needed:
- 15 case studies
- 15 copies of EACH problem solving strategy
- 6 copies of the presentation evaluation rubric (3 complete copies for the teacher, 1
copy per group)
- 3 copies of each character and role description
- white board/chalk board (SmartBoard if preferred)
- 15 follow-through activity rubrics
- 15 white lab coats (optional)
Time: 45 minutes
Step 1: Pre-Instructional Activities:
1. Students will enter to find 3 stations. Each student will find their assigned seat
at 1 of the 3 stations with their lab coat (optional), 3 printed problem solving
strategies, a case study and copy of the evaluation rubric on their desk. Each
student’s name will be on a paper with the typed name of the House M.D.
character they will be playing and their group role assignment, with a definition
of their duties. (Evaluator - Dr. House, Scribe - Dr. Cameron, Initiator/Leader -
Dr. Chase, Researcher - Dr. “Thirteen”, Elaborator - Dr. Foreman - use role
assignments for differentiation/ modification as needed)
2. The board will read
1. “Internship Day 4 - The Hippocratic Oath”
2. “Bell Work (15 Minutes) -
1. Quickly summarize the case study given.
2. Review the problem solving strategies provided.
3. Assuming your role in the group, analyze and select the most appropriate
strategy. Be prepared to justify your selection.
4. Be prepared to present your selection to your “colleagues.”
5. P.S. Every group member will participate! See the rubric for your
individual questions.
Step 2: Content Presentation:
1. When faced with a problem, there is almost always more than one way to solve it
(Unless its algebra… then, do what the teacher says!). Many times, we can use
our peers or “colleagues” to help us consider different approaches. As you can
imagine, different approaches and strategies can lead us to very different
answers. Sometimes, like in yesterdays lesson, thinking outside the box can
expose new solutions. Other times, problems need to be addressed in a clearly
defined and systematic way.
2. Doctors have to choose which approach is the best on a patient-by-patient basis.
If they are right, the patient has a favorable prognosis (outcome). If they choose
incorrectly, it can lead to devastating prognoses and even death. In order to
fulfill the hippocratic oath, they must do no harm. That includes choosing the
right diagnostic approach to ensure that they help, not hurt, their patient.
3. As a group, you will present the problem solving approach that you selected was
best suited to solve this patients problem. Refer to your rubric BEFORE your
presentation to know what you will be graded on. Although this is a group
activity, you will be graded as individuals. Remember to use appropriate medical
terminology where needed and be prepared to justify your answers.
Step 3: Learner Participation:
1. Call each group up to present their selection and justification one at a time. Ask
them to introduce themselves as the character they were assigned. (This helps
their “colleagues” know what role they played and the teacher to know if they
participated in the group activity as they should have.)
2. Each presentation should include: (10 minutes per group maximum)
1. Dr. Cameron (Scribe) - Of the 3 provided approaches, which was eliminated
first and why? What process did the group go through and what criteria was
used in order to pair it down? Were the criteria effective?
2. Dr. “Thirteen” (Researcher) - Of the 2 strategies left, were these researched
based approaches or a unique approaches based on individual patient case?
Which did your group think was more appropriate?
3. Dr. Chase (Initiator) - What was your final selection and how did you arrive at
that decision? Provide details about your group interaction that helped you all
in your selection.
4. Dr. Foreman (Elaborator) - Using specifics from the case study for justification,
how did the information provided make the selected approach the best fit?
Were any “outside” (not in the given problem solving approaches) ideas or
criteria used in the groups decision making process?
5. Dr. House (Evaluator) - Did your group conclude that this approach for solving
the medical problem was in compliance with the “do no harm” of the
hippocratic oath? Would your patient’s prognosis have been different if you
had selected another strategy? Was this strategy just the lesser of the evils
you had to choose from or was it in fact the best fit?
Step 4: Assessment:
Formative assessment of this objective will be based on teacher observation and
student-teacher interaction. By moving about the room, listening to group discussion
and listening to student questions (answering as few as possible, unless about the
directions) will provide the instructor with valuable information about student
readiness and mastery. The summative assessment will be in the form of a rubric-
graded (see appendix D) presentation and homework activity (optional). The questions
for each group member, not only ensures their active participation, but also requires
that they offer justification for part of the selection process, allowing students to
show mastery of selection by justifiable means on an individual bases.
Step 5: Follow-Through Activities:
Students will be assigned a reflection essay on their groups decision making process.
It should include an opportunity for students to express their attitude toward the
group activity, if they agreed with the groups decision, what if any modifications
should be applied to the selected strategy and justification for another selection if
they were to make a different choice. The rubric should be provided to students to
clarify instructions and ensure all elements to individually demonstrate mastery, for
the entire process, are present.
Lesson 4 Case Study
Case 4: Just a Bruise?Author: Adam L. Hartman, MDPreceptor: Anne M. Comi, MDDISCLOSURESNovember 21, 2003
IntroductionA 20-month-old girl presents to the emergency department after falling from her couch, hitting her head on a coffee table, and then becoming sleepy. Her parents deny any history of epistaxis, hematuria, hematochezia, or melena.
They witnessed no seizure activity and state that she is not a particularly clumsy child.
The family history is significant for a paternal aunt who underwent surgery to "remove some bleeding around her brain" and a paternal grandmother who suffered a hemorrhagic stroke at the age of 35 years. A choroid plexus cyst had been noted in the child in utero, and the mother's pregnancy, labor, and delivery were significant for borderline hypertension. The patient was born at 41 weeks by induced vaginal delivery with a birthweight of 4290 g and Apgar scores of 9 at 1 minute and 10 at 5 minutes. Her development has been normal.
On examination, the child was alert and very active, and all growth parameters were noted to be normal. The findings of her general exam were unremarkable. Neither cutaneous vascular skin lesions nor organomegaly was found. Her neurologic exam revealed normal cranial nerves, motor function, reflexes, coordination, and gait.The child's complete blood cell count and prothrombin and partial thromboplastin times were normal for her age.
P R O B L E M S O LV I N G S T R AT E GY 1
Scientific Method1. Identify the Problem2. Form a Hypothesis3. Test the Hypothesis4. Analyze Data5. Communicate Results
P R O B L E M S O LV I N G S T R AT E GY 2
KWL Chart
P R O B L E M S O LV I N G S T R AT E GY 3
Creative Approach1. Recognize/Identify Problem2. Get the Facts - What exactly happened?3. Explore What Happened and How it Connects with Your Prior Knowledge4. Brainstorm Possible Hypotheses (more than 1)5. What Do You Need to Prove Your Hypothesis Right?
Know Want/Need To Know Learned
What information were you given?
What information do you need or want to know?
What conclusion did that information lead you to?
Student Name:__________________________________________
Role: Dr. Cameron - ScribeCharacteristics: Documenting the problem solving selection process. Detailing the group’s sequence in arriving at conclusions.
Questions You Will Be Asked:1.Of the 3 provided approaches, which was eliminated first and why? 2. What process did the group go through and what criteria was used in order to pair it down? Were the criteria effective?
………………………………………………………………………………………………………………………………..
Student Name:__________________________________________
Role: Dr. “Thirteen” - ResearcherCharacteristics: Responsible for identifying research based problem solving approaches vs. creative approaches. Responsible for giving a detailed account of the group decision and justification for research based vs. creative selection.
Questions You Will Be Asked: 1.Of the 2 strategies left, were those researched based or unique approaches based on individual patient case? 2.Which did your group think was more effective?
Student Name:___________________________________________
Role: Dr. Chase - InitiatorCharacteristics: Responsible for initiating group conversation. Responsible for contributing and encouraging idea contributions from your group members.
Questions You Will Be Asked:1.What was your final selection and how did you arrive at that decision?2.Provide details about your group interaction that helped you all in your selection.
……………………………………………………………………………………………………………………………
Student Name:___________________________________________
Role: Dr. Foreman - ElaboratorCharacteristics: Responsible for providing justification for group decisions and decision making processes.
Questions You Will Be Asked:1.Using specifics from the case study for justification, how did the information provided make the selected approach the best fit?2.Were any “outside” (not given in the problem solving approaches) ideas or criteria used in the group’s decision making process?
Student Name:___________________________________________
Role: Dr. House - EvaluatorCharacteristics: Responsible for critically analyzing the efficiency and outcome of the group selection process. Offer insight into what other factors contributed and possible modifications to the problem solving selection process.
Questions You Will Be Asked:
1. Did your group conclude that this approach for solving the medical problem was in compliance with the “do no harm” of the hippocratic oath?
3. Would your patient’s prognosis have been different if your group had selected another strategy?
4. Was this strategy just the lesser of the evils you had to choose from or was it, in fact, the best fit?
Lesson 4 - The Hippocratic Oath - Group Presentation Rubric
Objective: Given 3 problem solving strategies/approaches and a case study, students will use problem solving sub-skills to create a presentation and accompanying justification of the group selection of the best strategy to apply to the patient in the case study, scoring a minimum of 3 on each evaluated area of the given rubric.
Group Feedback:
Lesson 4 - The Hippocratic Oath - Group Presentation Rubric
Group #: Presentation Time:
Group Members
1 2 3 4 5
1. Student Name:
Role
Dr. House - Evaluator Dr. Cameron - Scribe Dr. Chase - Evaluator
Dr. “Thirteen” - Researcher Dr. Foreman - Elaborator
Area of Evaluation 1. Not Evident 2. Approaching Competency 3. Competent
1. Of the 3 provided approaches, which was eliminated first?
Student response did not include an answer for this question and/or provided an inaccurate representation of the group’s decision.
N/A
Student response included an accurate representation of the
group’s primary elimination.
What process did the group go through and what criteria was used in order to pair it down?
Student response did not include and/or
contained 1 or fewer steps of the group process used to
eliminate one approach.
Student response included a 2-3 steps of the group process used
to eliminate one approach.
Student response included a
comprehensive account of 4 or more steps of
the group process used to eliminate one
approach.
3. Were the criteria effective? Please justify.
Student response did not include an answer
for this question and/or 1 of fewer justifications
for criteria effectiveness.
Student response included a response to effectiveness of criteria
and included 2-3 justifications for criteria effectiveness. (answer
lacked confidence)
Student response included a well thought
out answer to effectiveness of criteria
and 3 or more comprehensive
justifications for criterial effectiveness.
4. Group Participation
Student did not participate and/or did
not positively contribute to the group process.
Student was attentive to group activity but
contributed 2 or fewer ideas and/or was unsure of group
process.
Student was attentive to group activity,
positively influenced group process and
contributed 3 or more ideas.
6. Presentation Skills
Student presentation did not include
appropriate 2 or more of the presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Student presentation included 3 of the presentation skills
including preparedness, appropriate speaking
voice, eye contact and professional behavior.
Student presentation included EACH of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Feedback:
2. Student Name:
Role
Dr. House - Evaluator Dr. Cameron - Scribe Dr. Chase - Evaluator
Dr. “Thirteen” - Researcher Dr. Foreman - Elaborator
Area of Evaluation 1. Not Evident 2. Approaching Competency 3. Competent
1. Of the 2 strategies left, were these research based approaches or
unique approaches based on the individual patient
case.
Student response did not include an answer for this question and/or did not
provide a research based justification for this
determination.
Student response included an accurate
answer to the question but did not offer sufficient
research used for the justification for their
determination.
Student response included an accurate and comprehensive answer to
the question along with well researched
justification for their determination.
2. Which did your group think was more
appropriate and why?
Student response did not include an answer for this
question, inaccurately represented the group consensus and/or 1 or fewer justifications for groups determination
process..
Student response included an accurate representation of the
group consensus and 2-3 justifications that aided in the groups determination
process..
Student response included an accurate representation of the
group consensus and 4 or more justifications that
aided in the groups determination process.
3. Group Participation
Student did not participate and/or did not
positively contribute to the group process.
Student was attentive to group activity but
contributed 2 or fewer ideas and/or was unsure
of group process.
Student was attentive to group activity, positively
influenced group process and contributed 3 or more
ideas.
4. Presentation Skills
Student presentation did not include appropriate 2
or more of the presentation skills
including preparedness, appropriate speaking
voice, eye contact and professional behavior.
Student presentation included 3 of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Student presentation included EACH of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Feedback:
3. Student Name:
Role
Dr. House - Evaluator Dr. Cameron - Scribe Dr. Chase - Evaluator
Dr. “Thirteen” - Researcher Dr. Foreman - Elaborator
Area of Evaluation 1. Not Evident 2. Approaching Competency 3. Competent
1. What was your groups final selection?
Student response did not included an answer to this question or inaccurately represented the group’s
final selection of problem solving strategy.
N/A
Student response included an accurate representation of the
group’s final selection of problem solving strategy.
2. How did you arrive at that decision?
Student response did not include an answer to this
question and/or 1 or fewer steps of the
process the group used to make a final selection for
a problem solving strategy.
Student response included 2-3 steps and
moderate level of detail of the process the group used to make a final
selection for a problem solving strategy.
Student response included 4 or more
detailed steps the group used to make a final
selection for a problem solving strategy.
3. Provide details about your group interaction
that helped you all in your selection.
Student response included 1 or fewer
details of how group interaction assisted in the determination of the final problem solving strategy
selection.
Student response included 2-3 details of how group interaction
assisted in the determination of the final problem solving strategy
selection.
Student response included 4 or more details of how group interaction
assisted in the determination of the final problem solving strategy
selection.
Group Participation
Student did not participate and/or did not
positively contribute to the group process.
Student was attentive to group activity but
contributed 2 or fewer ideas and/or was unsure
of group process.
Student was attentive to group activity, positively
influenced group process and contributed 3 or more
ideas.
Presentation Skills
Student presentation did not include appropriate 2
or more of the presentation skills
including preparedness, appropriate speaking
voice, eye contact and professional behavior.
Student presentation included 3 of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Student presentation included EACH of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Feedback:
4. Student Name:
Role
Dr. House - Evaluator Dr. Cameron - Scribe Dr. Chase - Evaluator
Dr. “Thirteen” - Researcher Dr. Foreman - Elaborator
Area of Evaluation 1. Not Evident 2. Approaching Competency 3. Competent
1.Using specifics from the case study for
justification, how did the information provided make the selected
approach the best fit?
Student response included 1 or fewer
ACCURATE details from the information found in
the case study that was a key determining factor in
selecting the best problem solving strategy and/or did not provide a
response to this question.
Student response included 2-3 ACCURATE
details from the information found in the
case study that was a key determining factor in
selecting the best problem solving strategy.
Student response included 4 or more
ACCURATE details from the information found in
the case study that was a key determining factor in
selecting the best problem solving strategy.
2. Were any “outside” (not in the given problem
solving approaches) ideas or criteria used in the
groups decision making process?
Student response did not include an answer for this
question and/or inaccurately represented the inclusion of outside ideas or criteria in the
decision making process of the group.
Student response included a an incomplete representation of outside ideas or criteria and/or an
apparent lack of group decision making process.
Student response included a comprehensive and accurate inclusion of
all outside ideas or criteria used in the group
decision making process.
3. Group Participation
Student did not participate and/or did not
positively contribute to the group process.
Student was attentive to group activity but
contributed 2 or fewer ideas and/or was unsure
of group process.
Student was attentive to group activity, positively
influenced group process and contributed 3 or more
ideas.
4. Presentation Skills
Student presentation did not include appropriate 2
or more of the presentation skills
including preparedness, appropriate speaking
voice, eye contact and professional behavior.
Student presentation included 3 of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Student presentation included EACH of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Feedback:
5. Student Name:
Role
Dr. House - Evaluator Dr. Cameron - Scribe Dr. Chase - Evaluator
Dr. “Thirteen” - Researcher Dr. Foreman - Elaborator
Area of Evaluation 1. Not Evident 2. Approaching Competency 3. Competent
1. Did your group conclude that this
approach for solving the medical problem was in compliance with the “do
no harm” of the hippocratic oath?
Student response did not include an answer for this
question and/or presented an inaccurate conclusion of the groups
determination of compliance with the
hippocratic oath.
N/A
Student response included an accurate representation of the groups conclusion of compliance with the
hippocratic oath.
2. Would your patient’s prognosis have been different if you had selected another
strategy?
Student response did not include an answer for this question and/or included 1 or fewer hypotheses of
how the patient’s prognosis would have
been effected had another problem solving
strategy been used.
Student response included 2 reasonable hypotheses of how the
patient’s prognosis would have been effected had another problem solving
strategy been used.
Student response included a logical
discussion of 3 or more reasonable hypotheses of
how the patient’s prognosis would have
been effected had another problem solving strategy had been used.
3. Was this strategy just the lesser of the evils you
had to choose from or was it, in fact, the best fit for this specific problem?
Student response did not included an answer to this
question.
Student response included a single yes/no answer for this question
but did not include justification for their
conclusion.
Student response included a logical and
comprehensive discussion to answer the
question along with a justification for their
conclusion.
4. Group Presentation
Student did not participate and/or did not
positively contribute to the group process.
Student was attentive to group activity but
contributed 2 or fewer ideas and/or was unsure
of group process.
Student was attentive to group activity, positively
influenced group process and contributed 3 or more
ideas.
5. Presentation Skills
Student presentation did not include appropriate 2
or more of the presentation skills
including preparedness, appropriate speaking
voice, eye contact and professional behavior.
Student presentation included 3 of the presentation skills
including preparedness, appropriate speaking
voice, eye contact and professional behavior.
Student presentation included EACH of the
presentation skills including preparedness,
appropriate speaking voice, eye contact and professional behavior.
Feedback: